Hemiplegic Migraine: A Pediatric Case Study

• Published in: Archives of clinical neuropsychology 2013-01, Vol.28 (6), p.2-2
• Main Authors: Loughan, A, Perna, R, Hertza, J, Northington, S, Tyson, K
• Format: Article
• Language: English
• ISSN: 0887-6177

Introduction: Migraine is the second most common type of headache and disabling brain disorder with prevalence estimates reaching 10.6% of children (ages 5-15 years) and 28% of adolescents (ages of 15-19 years). Despite its high incidence, migraine is commonly misdiagnosed. Evidence has pointed to a strong genetic component (familial hemiplegic migraine), but specific causative genes have not been identified. Migraine variants can have diverse presentations including focal transient neurological symptoms such as hemiplegia. The prevalence of hemiplegic migraines is 0.01%, making it a very rare disease. Limited case investigations have shown irreversible neurologic deficits and cerebellar atrophy. Methods: This proposed case will review the neuropsychological profile of a 12-year-old girl who was previously diagnosed and treated for multiple mild sports concussions. However, the diverse symptom presentation including intermittent hemiplegia, altered consciousness (12-24 h), aphasia, and cognitive dysfunction has led to diverse and at times incorrect diagnoses. In this child, symptom onset was often, but not always triggered by mild head trauma. Results: Conventional MRI (structural scans) was non-pathological, yet functional MRI found decreased left hemispheric functioning which is consistent with neuropsychological testing. Neuropsychological findings demonstrated significant score variability and impairments on multiple largely left hemisphere and executive functioning tasks. Conclusions: Specific cognitive impairments included a variety of left hemisphere cognitive skills (verbal comprehension, reading, bilateral executive deficits) and appear to suggest multifocal left hemisphere cerebral dysfunction. A focus will be placed on the importance of the clinical interview, history of symptoms, the family medical history, and genetic factors.